Parkinson's disease: neurological manifestations and possibilities for neurosurgery

Parkinson's disease is caused by the progressive degeneration of nerve cells that produce dopamine, a neurotransmitter essential for motor coordination. The most common symptoms of Parkinson's disease are resting tremors, muscle rigidity, slow voluntary movements and postural instability. Furthermore, the disease can cause cognitive, emotional, sensory and autonomic changes. There are two main types of neurosurgery for Parkinson's disease: ablative surgery and deep brain stimulation (DBS). Objective: to evaluate the impact of neurosurgery for Parkinson's disease in improving motor symptoms, reducing medication side effects, preserving cognitive functions and improving patients' quality of life. Methodology: followed the PRISMA checklist. The databases used were PubMed, Scielo, Web of Science and Google Scholar. The descriptors used were: “Parkinson's disease”, “neurosurgery”, “ablation”, “deep brain stimulation” and “outcome”. The inclusion criteria were: articles that compared the two types of neurosurgery for Parkinson's disease (ablative surgery and deep brain stimulation), that evaluated clinical outcomes (motor symptoms, medication side effects, cognitive functions and quality of life) and that used standardized scales to measure these outcomes. The exclusion criteria were: articles that did not compare the two types of neurosurgery for Parkinson's disease, that did not evaluate the clinical outcomes of interest, that used non-validated or inadequate scales to measure these outcomes. Results: 15 studies were selected. Both types of neurosurgery for Parkinson's disease have been effective in improving patients' motor symptoms, especially tremors, rigidity, and bradykinesia. However, deep brain stimulation had an advantage over ablative surgery in terms of reducing medication side effects, such as motor fluctuations and dyskinesias. Deep brain stimulation was also safer and less invasive than ablative surgery, presenting fewer complications such as hemorrhage, infection, neurological deficits, and cognitive or psychiatric changes. However, deep brain stimulation showed greater improvement than ablative surgery, especially in physical, emotional and social aspects of quality of life. Conclusion: neurosurgery for Parkinson's disease is a valid therapeutic option for patients who do not respond adequately to drug treatment or who have intolerable side effects. Among the two main types of neurosurgery for Parkinson's disease, deep brain stimulation appears to be superior to ablative surgery in terms of efficacy, safety, and impact on patients' quality of life.Parkinson's disease is caused by the progressive degeneration of nerve cells that produce dopamine, a neurotransmitter essential for motor coordination. The most common symptoms of Parkinson's disease are resting tremors, muscle rigidity, slow voluntary movements and postural instability. Furthermore, the disease can cause cognitive, emotional, sensory and autonomic changes. There are two main types of neurosurgery for Parkinson's disease: ablative surgery and deep brain stimulation (DBS). Objective: to evaluate the impact of neurosurgery for Parkinson's disease in improving motor symptoms, reducing medication side effects, preserving cognitive functions and improving patients' quality of life. Methodology: followed the PRISMA checklist. The databases used were PubMed, Scielo, Web of Science and Google Scholar. The descriptors used were: “Parkinson's disease”, “neurosurgery”, “ablation”, “deep brain stimulation” and “outcome”. The inclusion criteria were: articles that compared the two types of neurosurgery for Parkinson's disease (ablative surgery and deep brain stimulation), that evaluated clinical outcomes (motor symptoms, medication side effects, cognitive functions and quality of life) and that used standardized scales to measure these outcomes. The exclusion criteria were: articles that did not compare the two types of neurosurgery for Parkinson's disease, that did not evaluate the clinical outcomes of interest, that used non-validated or inadequate scales to measure these outcomes. Results: 15 studies were selected. Both types of neurosurgery for Parkinson's disease have been effective in improving patients' motor symptoms, especially tremors, rigidity, and bradykinesia. However, deep brain stimulation had an advantage over ablative surgery in terms of reducing medication side effects, such as motor fluctuations and dyskinesias. Deep brain stimulation was also safer and less invasive than ablative surgery, presenting fewer complications such as hemorrhage, infection, neurological deficits, and cognitive or psychiatric changes. However, deep brain stimulation showed greater improvement than ablative surgery, especially in physical, emotional and social aspects of quality of life. Conclusion: neurosurgery for Parkinson's disease is a valid therapeutic option for patients who do not respond adequately to drug treatment or who have intolerable side effects. Among the two main types of neurosurgery for Parkinson's disease, deep brain stimulation appears to be superior to ablative surgery in terms of efficacy, safety, and impact on patients' quality of life

APPROACH AND TREATMENT OF NON-MELANOMA SKIN CANCER DURING PREGNANCY

Pregnancy presents unique challenges in diagnosing and treating non-melanoma skin cancer, the most common type of skin cancer. Hormonal and immunological changes during pregnancy can influence the development and progression of the disease, while ethical issues and concerns about fetal safety complicate the therapeutic approach. Therefore, it is crucial to understand how this condition is managed during pregnancy to ensure the best outcome for mother and baby. Objective: The objective of this systematic literature review is to analyze the approaches and treatments used for non-melanoma skin cancer during pregnancy, with a focus on maternal and fetal safety. Methodology: The review followed the PRISMA checklist guidelines. Articles published in the last 10 years were searched in the PubMed, Scielo and Web of Science databases. The descriptors used were "non-melanoma skin cancer", "pregnancy", "treatment", "approach" and "fetal safety". The inclusion criteria were studies that described cases of non-melanoma skin cancer during pregnancy, addressing treatment options and fetal safety considerations. The exclusion criteria were studies irrelevant to the topic, studies without access to the full text and studies not available in English, Portuguese or Spanish. Results: Analysis of the articles revealed several therapeutic approaches for non-melanoma skin cancer during pregnancy, including surgery, photodynamic therapy and cryotherapy. There was an emphasis on the individualized assessment of each case, taking into account the stage of the disease, the location of the tumor and the potential risks for the mother and fetus. Prevention was also highlighted, with an emphasis on sun protection and skin self-examination. However, some treatments have been delayed until after birth due to concerns about fetal safety. Conclusion: The management of non-melanoma skin cancer during pregnancy requires a multidisciplinary and individualized approach, considering the risks and benefits for the mother and fetus. Prevention, early diagnosis and adequate treatment are essential to guarantee the best result for both. More research is needed to further guide clinical practices in this area.Pregnancy presents unique challenges in diagnosing and treating non-melanoma skin cancer, the most common type of skin cancer. Hormonal and immunological changes during pregnancy can influence the development and progression of the disease, while ethical issues and concerns about fetal safety complicate the therapeutic approach. Therefore, it is crucial to understand how this condition is managed during pregnancy to ensure the best outcome for mother and baby. Objective: The objective of this systematic literature review is to analyze the approaches and treatments used for non-melanoma skin cancer during pregnancy, with a focus on maternal and fetal safety. Methodology: The review followed the PRISMA checklist guidelines. Articles published in the last 10 years were searched in the PubMed, Scielo and Web of Science databases. The descriptors used were "non-melanoma skin cancer", "pregnancy", "treatment", "approach" and "fetal safety". The inclusion criteria were studies that described cases of non-melanoma skin cancer during pregnancy, addressing treatment options and fetal safety considerations. The exclusion criteria were studies irrelevant to the topic, studies without access to the full text and studies not available in English, Portuguese or Spanish. Results: Analysis of the articles revealed several therapeutic approaches for non-melanoma skin cancer during pregnancy, including surgery, photodynamic therapy and cryotherapy. There was an emphasis on the individualized assessment of each case, taking into account the stage of the disease, the location of the tumor and the potential risks for the mother and fetus. Prevention was also highlighted, with an emphasis on sun protection and skin self-examination. However, some treatments have been delayed until after birth due to concerns about fetal safety. Conclusion: The management of non-melanoma skin cancer during pregnancy requires a multidisciplinary and individualized approach, considering the risks and benefits for the mother and fetus. Prevention, early diagnosis and adequate treatment are essential to guarantee the best result for both. More research is needed to further guide clinical practices in this area